Vandetanib, Carboplatin, and Paclitaxel in Treating Patients With Stage I, Stage II, or Stage III Non-Small Cell Lung Cancer That Can Be Removed by Surgery

Assessment of Feasibility and Safety of the Addition of ZD6474 (Zactima) to Carboplatin and Paclitaxel Administered Neo-Adjuvantly in Stage IB, II and T3, N1 Non-Small Cell Lung Cancer (NSCLC)

RATIONALE: Vandetanib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving vandetanib together with chemotherapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.

PURPOSE: This phase II trial is studying how well giving vandetanib together with carboplatin and paclitaxel works in treating patients with stage I, stage II, or stage III non-small cell lung cancer that can be removed by surgery.

Study Overview

• Status: Terminated
• Conditions: Lung Cancer
• Intervention / Treatment: Drug: carboplatin; Drug: paclitaxel; Drug: Zactima; Procedure: neoadjuvant therapy

Detailed Description

OBJECTIVES:

Primary

• Determine the feasibility of neoadjuvant vandetanib in combination with carboplatin and paclitaxel in patients with resectable stage IB, II, or IIIA non-small cell lung cancer.

Secondary

• Assess the 30-day postoperative mortality rate in these patients.
• Assess the toxicity of this regimen in these patients.
• Determine the percentage of patients who complete all planned courses of therapy.
• Assess the clinical response rate in patients treated with this regimen.
• Assess the pathologic complete response rate in patients treated with this regimen.

OUTLINE: This is a multicenter study.

Patients receive oral vandetanib once daily on days 1-21. Patients also receive paclitaxel IV over 3 hours and carboplatin IV over 1 hour on day 1. Treatment repeats every 3 weeks for up to 3 courses.

Patients undergo surgery at least 3 weeks after the last course of chemotherapy.

PROJECTED ACCRUAL: A total of 15 patients will be accrued for this study.

• Study Type: Interventional
• Enrollment (Actual): 2
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Michigan
    • Detroit, Michigan, United States, 48201-1379
      • Barbara Ann Karmanos Cancer Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 120 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed non-small cell lung cancer (NSCLC), meeting 1 of the following staging criteria:

  • Stage IB or II disease
  • T3, N0-1 disease (stage IIIA)
• Deemed a surgical candidate
• No prior lung cancer (NSCLC or small cell lung cancer)

PATIENT CHARACTERISTICS:

• ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
• WBC ≥ 3,000/mm³
• Absolute neutrophil count ≥ 1,500/mm³
• Platelet count ≥ 100,000/mm³
• Bilirubin normal
• AST and ALT ≤ 2.5 times upper limit of normal (ULN)
• Creatinine ≤ 1.5 times ULN
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No evidence of severe or uncontrolled systemic disease or any concurrent condition that, in the opinion of the investigator, would preclude study compliance
• No peripheral neuropathy ≥ grade 2
• No hemoptysis within the past 12 weeks
• No spontaneous bleeding within the past 12 weeks
• No clinically significant cardiac event (e.g., NYHA class II-IV heart disease, myocardial infarction) within the past 3 months

• No history of asymptomatic sustained ventricular tachycardia or arrhythmia that is symptomatic or requires treatment, including any of the following:

  • Multifocal premature ventricular contractions
  • Bigeminy
  • Trigeminy
  • Ventricular tachycardia

  • Uncontrolled atrial fibrillation

    • Atrial fibrillation controlled with medication allowed
• No history of QTc prolongation as a result from other medication that required discontinuation of that medication
• No congenital long QT syndrome or first-degree family relative with an unexplained death before the age of 40
• No left bundle branch block

• No QTc with Bazett's correction that is unmeasurable or QTc ≥ 480 milliseconds on screening ECG

  • Patients with QTc ≥ 480 milliseconds on screening ECG may have ECG repeated twice

    • Average QTc from the 3 screening ECG's must be < 480 milliseconds
• No uncontrolled hypertension (systolic BP > 160 mm Hg or diastolic BP > 100 mm Hg)
• No active diarrhea or active gastrointestinal disease that may affect the absorption of study drugs or ability to tolerate study drugs
• No other malignancy within the past 3 years except in situ cervical carcinoma or adequately treated basal cell or squamous cell carcinoma of the skin

PRIOR CONCURRENT THERAPY:

• More than 4 weeks since major surgery and recovered
• No prior carboplatin, paclitaxel, or vandetanib
• More than 30 days since prior investigational agents

• More than 2 weeks since prior and no concurrent drugs that induce CYP3A4 including, but not limited to, any of the following:

  • Rifampin
  • Phenytoin
  • Carbamazepine
  • Barbiturates
  • Hypericum perforatum (St. John's wort)
• No medication that may cause QTc prolongation or induce torsades de pointes for 2 weeks prior to beginning study treatment, during, and for 2 weeks after completion of study treatment
• No concurrent combination antiretroviral treatment for HIV-positive patients
• No other concurrent investigational agents

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: Zactima, Paclitaxel, Carboplatin; Zactima- 100 mg orally daily, starting on day 1 of cycle 1. Paclitaxel- 200mg/m2 IV, every 3 weeks starting on day 1 of cycle 1. Carboplatin AUC6 IV, every 3 weeks starting on day 1 of cycle 1 Duration of each cycle: 21 days. The last dose of zactima will be on the first day of the last cycle. Neoadjuvant Surgery: Surgical resection of the tumor will be performed after the resolution of all the adverse effects from the last cycle of treatment but no earlier than 3 weeks after the last cycle of treatment.

Drug: carboplatin; Carboplatin AUC6 IV, every 3 weeks starting on day 1 of cycle 1; Other Names: Paraplatin ®; Drug: paclitaxel; Paclitaxel- 200mg/m2 IV, every 3 weeks starting on day 1 of cycle 1.; Other Names: Taxol ®; Onxal TM; Drug: Zactima; Zactima- 100 mg orally daily, starting on day 1 of cycle 1.; Other Names: ZD6474; Caprelsa; Vandetanib; Procedure: neoadjuvant therapy; Neoadjuvant surgery: Surgical resection of the tumor will be performed after the resolution of all the adverse effects from the last cycle of treatment but no earlier than 3 weeks after the last cycle of treatment.; Other Names: R0 Resection

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Complete Resection (R0) Rate	Following three cycles of pre-operative zactima and carboplatin/paclitaxel

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-Operative Mortality Rate		at 30 days
Assess Toxicity of This Regimen and the Percentage of Patients Completing All Planned Cycles of Therapy	Serum chemistry includes Albumin, alkaline phosphatase, total bilirubin, bicarbonate, BUN, calcium, chloride, creatinine, glucose, potassium, total protein, SGOT [AST], SGPT [ALT], sodium, laboratory tests should be done on a weekly basis for the first cycle. After the first cycle laboratory tests should be done within 72 hours of each dose of carboplatin/paclitaxel.	Weekly for the first cycle; Thereafter within 72 hours of each dose of carboplatin/paclitaxel
Assess the Clinical Response Rate of the Proposed Pre-operative Regimen	Patients will undergo tumor evaluation when all of the three cycles have been completed unless the treating physician has concerns regarding tumor progression. If the patient has undergone tumor evaluation prior to the last cycle the patient will require repeat tumor assessment within 4 weeks of completion of the last cycle of therapy	End of three cycles of treatment
Assess the Complete Pathologic Complete Response (CR) Rate With This Regimen.	Evaluation of the number of patients who have no evidence of tumor in the resected tumor.	30 days post surgery

Collaborators and Investigators

• Sponsor: Barbara Ann Karmanos Cancer Institute
• Collaborators: National Cancer Institute (NCI)

Publications and helpful links

Helpful Links

• Clinical trial summary from the National Cancer Institute's PDQ® database

Study record dates

Study Major Dates

• Study Start: July 1, 2007
• Primary Completion (ACTUAL): January 1, 2008
• Study Completion (ACTUAL): October 1, 2008

Study Registration Dates

• First Submitted: April 9, 2007
• First Submitted That Met QC Criteria: April 9, 2007
• First Posted (ESTIMATE): April 11, 2007

Study Record Updates

• Last Update Posted (ACTUAL): March 26, 2019
• Last Update Submitted That Met QC Criteria: March 13, 2019
• Last Verified: February 1, 2013

More Information

Terms related to this study

• Keywords: stage IIIA non-small cell lung cancer; stage I non-small cell lung cancer; stage II non-small cell lung cancer
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Neoplasms; Lung Diseases; Neoplasms by Site; Respiratory Tract Neoplasms; Thoracic Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Antineoplastic Agents, Phytogenic; Carboplatin; Paclitaxel
• Other Study ID Numbers: CDR0000539273; P30CA022453 (U.S. NIH Grant/Contract); WSU-2006-122 (OTHER: Barbara Ann Karmanos Cancer Institute); WSU-011807MP2F (OTHER: Wayne State University - Human Investigation Committee); WSU-0612004427 (OTHER: Wayne State University - Human Investigation Committee); ZENECA-IRUSZACT0029